Sleep Tips can Prevent Infant Death

Published by Contra Costa Times

Posted on Wed, Apr. 05, 2006

By Jim Carpenter, M.D., MPH

FEW TRAGEDIES are more heartrending than the sudden unexpected death of an infant. For example, parents lovingly put their healthy infant to sleep, only to find their precious baby dead in the morning, for no apparent reason.

We have about a dozen infant deaths each year in Contra Costa County, divided between SIDS and co-sleeping deaths. Sudden Infant Death Syndrome, or SIDS, is the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation and autopsy.

In California, 175 children died of SIDS in 2003, the leading cause of death of infants between 1 month and 1 year old. The majority of these were associated with unsafe sleeping practices.

Co-sleeping is when the parents share their bed or couch with their infant children. The Consumer Product Safety Commission reports at least 515 infant and toddler deaths in the United States from co-sleeping between 1990-1997.

For this reason, many child health experts, including the American Academy of Pediatrics, recommend against co-sleeping.

The cause of SIDS is unknown, but there are ways to minimize the risk.

Back to sleep: Infants should be placed on their backs (face up) whenever they sleep. If they fall asleep in another position, they should be gently put on their backs.
Firm sleep surface: Always use a firm crib mattress that fits the crib snugly and is covered by a tight-fitting sheet.
Avoid soft objects in the crib: Never put in pillows, quilts, comforters, sheepskins, stuffed toys and other soft objects, no matter how cuddly they appear.
No smoking: Don't smoke while pregnant, and avoid exposing the infant to tobacco smoke. Remind relatives and baby sitters of this.
Consider using a pacifier: Pacifier use is associated with decreased risk of SIDS. Insert when placing infant down for sleep, but not after the infant falls asleep.
Avoid overheating: The infant should be lightly clothed for sleep with the temperature of the room comfortable for a lightly clothed adult.
Avoid commercial devices. Neither special mattresses nor home breathing monitors have been shown to reduce the risk of SIDS.
To avoid flattening the back of the infants head (from sleeping on the back), encourage "tummy time" when awake.
Avoid excessive time in car-seat carriers and "bouncers," which also put pressure on the back of the head. Place the infant to sleep with the head towards alternating sides of the bed. This may increase infant movement during the sleeping time, and lessen head flattening.
Be sure that others caring for the infant, such as child care providers, relatives, friends, and baby sitters, are aware of these recommendations.

Co-sleeping or bedsharing can lead to smothering and suffocation. It's safer to place the infant in an approved crib or bassinet next to the bed, allowing parents to be nearby, but avoiding the hazards of co-sleeping.

If you choose to sleep with your infant, against medical experts' recommendations, do not smoke, nor use alcohol or drugs that can deepen your sleep. In particular, never co-sleep on a couch, because its softness and shape can lead to suffocation.

For more information on safe sleeping tips for infants, call the Contra Costa SIDS Program at 925-313-6254 or visit cchealth.org/topics/sids.

Carpenter is a pediatrician at Contra Costa Health Centers in Richmond and Martinez, and chair of the Contra Costa Child Death Review Team.